Introduction

Less than full time training is the means by which trainees undertake their training when they are unable to work and train full time for “well-founded” reasons. The NHS is committed to flexible working arrangements across the health economy and less than full time training is a method by which trainees can utilise the less than full time training scheme to balance their work and personal lives, as well as assisting those trainees who are in poor health or those who have a disability.

Purpose

The purpose of this policy is to clarify how the less than full time training scheme works, who is eligible to apply and the arrangements necessary to secure approval. The scheme is also intended to make a meaningful contribution to the principles of equality and diversity, particularly in relation to working parents and trainees with a disability.

The policy also aims to demonstrate that Health Education England working across the South West recognises the demographic trends in the medical workforce and we are therefore committed to promoting and supporting access to less than full time training opportunities for eligible applicants.

Scope

This policy applies to all trainees taking up appointments in Specialty Training or Foundation posts that are both educationally approved by Health Education England working across the South West and the General Medical Council (GMC) and applies to the following grades: -

Foundation Year 1 (F1)

Foundation Year 2 (F2)

Core Trainees (CT1 – CT3)

GP Specialty Registrars (ST1 – 3)

Specialty Registrars (StR)

Academic Clinical Fellows (ACF)

Clinical Lecturers (CL)

This policy is written to complement ‘A Reference Guide for Postgraduate Specialty Training in the UK (Gold Guide, seventh edition)’. It is recommended that trainees review the Gold Guide in addition to this policy.

Eligibility

All trainees are eligible to apply for less than full time working. Those wishing to do so must show that training on a full time basis would not be practical for them for well-founded individual reasons.

The only requirement to be permitted to train less than full time is a well founded individual reason. Reasons for needing to train on a less than full time basis are put into two main categories for the purpose of assessing eligibility. However, these categories are not exhaustive.

Category 1

Those doctors in training with:

Disability or ill health (this may include ongoing medical procedures such as fertility treatment);

Responsibility for caring (men or women) for children;

Responsibility for caring for ill/disabled partner, relative or other dependant.

Category 2

Those doctors in training with:

Unique opportunities

A trainee is offered a unique opportunity for their own personal/professional development and this will affect their ability to train full time (e.g. training for national/international sporting events or a short-term extraordinary responsibility such as a national committee or continuing medical research as a bridge to progression in integrated academic training).

Religious commitment

A trainee has a religious commitment that involves training for a particular role and requires a specific time commitment resulting in the need to work less than full time.

Non-medical development

A trainee is offered non-medical professional development (e.g. management courses, law courses or fine arts courses), which requires a specific time commitment resulting in the need to work less than full time.

Category 1 applicants will have priority and will be supported by Health Education England working across the South West.

Access to category 2 is dependent on individual circumstances and the availability of funding.

Other well-founded reasons will be considered for less than full time training but will be prioritised for the Postgraduate Dean (or nominated deputy) and will be dependent on the capacity of the programme and available resources.

Subject to eligibility, trainees may train less than full time from the outset or transfer from full time to less than full time (and back again if required).

Where a trainee no longer wishes or is no longer eligible to work on a less than full time basis they will return to full time training when an appropriate placement becomes available. Until that time the trainee will continue to work on a less than full time basis.

Any trainee wishing to work less than full time must have obtained a post in open competition. Unless advertised to the contrary, all competitively appointed posts are offered on a full time basis. If a trainee wishes to work less than full time they must notify the relevant Manager of their intentions at their earliest opportunity and not less than three months’ notice.

It must be on letter-header paper or be from an official email address which can be validated. The letter should be dated within the past 3 months.

Until end of training

Responsibility for care for children

You will need to confirm the anticipated or actual date of birth of your youngest child on the online application form. (Please note you do not need to continue to re-apply upon each period of maternity leave, eligibility is automatic until your youngest child is 18 years old).

Until youngest child is 18 years’ old

Responsibility for caring for ill/disabled partner, relative or other dependent

A letter from your GP or Medical Specialist involved in the care of your partner/relative/dependent which includes:

Level of care anticipated that you will need to provide

It must be on letter-header paper or be from an official email address which can be validated, dated within the last three months.

Until end of training

Category 2

All circumstances

Complete the free text boxes on the online application form detailing the nature of your request. You can attach letters of support and job descriptions to the application form should you wish.

Category 2 applications will be reviewed on a regular basis and continuation is not automatic.

Less than full time applications without the supporting evidence requested will not be accepted. The trainee will be sent a response informing them we are unable to proceed with their application and their application has been declined. The trainee will need to resubmit a new application once they have the required evidence. Should they not submit a new application with the evidence requested above, we will assume they wish to continue training full time.

Funding Arrangements

Health Education England working across the South West funds the educational component of the basic salary and pay enhancements are the responsibility of the employer. These funding arrangements are intended to avoid financial disincentives for employers. The availability of less than full time training is ultimately dependent on available funding from Health Education England and the employers; however, where possible, appropriate measures will be taken to facilitate access.

Where a trainee is supernumerary Health Education England working across the South West will provide the educational component of the basic salary up to a maximum 60% of the full time basic salary based on the formula used for full time trainees. The hours that attract a pay enhancement will be provided by the employing Trust.

Where two trainees slot-share Health Education England working across the South West will provide funding for the additional component of the basic salary, see example below:

Where two trainees slot-share in a full time post at 60% (0.6 of the full time basic salary) Health Education England working across the South West will fund the additional 0.2 element of the basic salary. The hours that attract a pay enhancement for both trainees will be agreed by the employing Trust.

Training Placements

Less than full time training may be undertaken in one of three ways listed below.

Slot-Sharing

Slot-sharing works on the basis that two trainees occupy one full time post and manage the out of hours work between them as agreed by the employer.

Each trainee may work up to 60% whole time equivalent. Health Education England working across the South West will provide surplus funding as an incentive to the employer to support the less than full time training placement.

Slot-share trainees must agree their working pattern with their Educational Supervisor to ensure educational and service needs are met. Flexibility will be required where specific working days are required by either or both parties. Typically slot-sharers will work separate days of the week with overlap on one day or more.

Opportunities for slot-sharing must be explored before any alternative arrangements are considered. Any trainee supernumerary or part time in a full time slot will be required to slot-share should the opportunity arise.

Part Time in a Full Time Slot

A trainee occupies an established full time post but works reduced hours.

As an established post no additional funding will be provided, however the employer may utilise any surplus funds to backfill any service gap.

A trainee may work up to 0.9 whole time equivalent when part time in a full time slot, however, should there be a requirement to slot-share the trainee will be required to reduce their working hours to facilitate this. Trainees will be given three months’ notice of this change.

The trainee must complete the same approval paperwork even though there is no financial implication to the employing Trust.

Supernumerary

Supernumerary posts are those that are in addition to the usual complement of training posts in an employing Trust.

This option may only be considered provided there is no detrimental effect on other trainees within the training programme.

Supernumerary placements will only be considered where slot-share arrangements or having a part time trainee in a full time slot is not practical. Examples would be those in ill health and those with dependants who suddenly need increased care.

Health Education England working across the South West will provide the educational component of the salary up to 60% whole time equivalent. Any hours that attract a pay enhancement will be agreed and paid for by the employing Trust.

Rotations

Trainees will normally be expected to move between posts within rotations on the same basis as a full time trainee in the same specialty, to ensure they receive a coherent programme of training that is educationally comparable with full time trainees.

Trainees on a programme that rotate through different specialties, such as the Foundation Training Programme, Internal Medical Training, General Practice and Core Surgical Training may find their rotations change to enable opportunities to slot-share.

Trainees working less than full time may also find that their completion date for training may not correspond with August.

Working Hours

Less than full time training is counted exactly the same as full time work in all respects. The table below should be used as a guide and will assist in calculating the less than full time training required to meet the full time equivalent quota for training.

%

6

Months

12

Months

18

Months

24

Months

30

Months

36

Months

50% WTE

12

Months

24

Months

36

Months

48

Months

60

Months

72

Months

60% WTE

10

Months

20

Months

30

Months

40

Months

50

Months

60

Months

70% WTE

9

Months

17

Months

26

Months

34

Months

43

Months

51

Months

80% WTE

8

Months

15

Months

23

Months

30

Months

38

Months

45

Months

90% WTE

7

Months

13

Months

20

Months

27

Months

33

Months

40

Months

For example, a trainee on a three-year full time training programme working 60% whole time equivalent will take 60 months (five years) to complete, subject to satisfactory progression.

It should be noted that opportunities for slot-sharing will be explored before any alternative working arrangements are considered. To facilitate opportunities to slot-share trainees will work up to 60% whole time equivalent. Where this results in a reduction to the total working hours trainees will be give three months’ notice of any change.

In line with the GMC position statement on less than full time training (October 2011), trainees will be required to undertake no less than 50% full time training.

Only where a trainee experiences exceptional difficulties may the Postgraduate Dean reduce the time requirement further. The absolute minimum is 20% of full time training with the expectation that trainees should not take a placement at this level for more than 12 months.

For further information refer to the ‘GMC position statement on less than full time training – October 2011’ available on the website.

Out of Hours Work

Day time working, on-call and out of hours duties will be undertaken on a pro-rata basis to that worked by full time trainees in the same grade and specialty.

The only exceptions to this are circumstances for less than full time training which make this inappropriate or impossible, provided legal and educational requirements are met.

Undertaking 'Other Work' Whilst Training Less Than Full Time

Trainees on less than full time placements are not precluded from undertaking other work although they should ensure that in undertaking this work they practice according to the GMC’s good medical practice and that this does not impact negatively on their training.

Where undertaking additional work within the remit of holding a licence to practice the trainee must utilise the annual submission of the Form R to ensure the Postgraduate Dean as their designated Responsible Officer is aware.

Pay

The basic pay for doctors training less than full time is pro rata to the basic salary for a doctor employed full time calculated on an average of 40 hours per week.

Basic pay and pay enhancement queries should be directed to the employing Trust, usually via the Medical Staffing department.

For further information on pay please read the document ‘Doctors in flexible training – Equitable pay for flexible medical training’ available on the website.

Study Leave

Less than full time trainees are expected to make appropriate personal arrangements to access fixed training days when they are not rostered to work. This will require flexibility on part of the trainee to ensure they have access to all the educational components of the training programme equivalent to their full time counterparts.

Less than full time trainees should refer to the Study Leave guidelines available on the website for further information on the allocation and application process.

Frequency of ARCP

Less than full time trainees will have an ARCP at points where decision relating to progression in training are required and should be assessed not less than annually. There should be no more than a 15-month interval to facilitate Revalidation. Consequently, less than full time trainees will have more ARCPs than a full time trainee.

Acting Up

Less than full time trainees may apply for a period of acting up as a consultant, up to a maximum of three months. The period acting up will be pro-rata for the three months. Please refer to the ‘Acting Up Policy.

Period of Grace

The purpose of the period of grace is to provide Specialty Registrars (excluding those in General Practice) time to secure a Consultant or other post following attainment of their CCT / CESR.

The maximum duration of the period of grace is six months whether the trainee is full time or less than full time.

Inter Deanery Transfer

Trainees accepted into the South West programme via an inter-deanery transfer who are already working less than full time will not have to re-establish eligibility; provided they have evidence of their eligibility to work less than full time from their originating organisation.

Application Process and Notice Period

Trainees should discuss any plans for less than full time training with their Training Programme Director before submitting an application. If the trainee is unaware of who their Training Programme Director is then they should contact the relevant Education Programme Manager.

Trainees must give at least three months’ notice of their wish to train less than full time to allow sufficient time for the employing Trust to be notified and to discuss with the Training Programme Director for the purposes of rotation planning. If less notice is received the trainee’s application will still be considered but the start date may be delayed.

Requests to train less than full time received at short notice on health grounds will be agreed on a case by case basis.

Appeals Process

An appeal is an opportunity to question a decision, or complain about treatment which a trainee considers to be unfair. An appeal will allow all parties to have the case heard before an independent panel, and a decision to be reached on the facts that have been presented.

Eligibility for Appeal

Trainees refused access to the less than full time training scheme are eligible to appeal.

The appeals process should not be used for:

Issues with the employing Trust relating to salary calculation or pay enhancements

Provision of out-of-hours in excess of those (if any) required for educational approval

Employers’ refusal to employ a less than full time trainee on costs grounds

Registering an Appeal

Appeals should be submitted using the ‘Notification of Appeal’ available from the website.

The Notification of Appeal form must be sent to the Postgraduate Dean within 15 working days of the decision about which you are appealing being made.

A copy of the Notification of Appeal should also be sent to neil.squires@hee.nhs.uk

Process Following an Appeal Being Registered

The trainee will be invited to attend an appeal hearing to be held within 15 working days of the submission of the appeal where possible.

The trainee will be required to provide a Statement of Case which will need to be provided to the Postgraduate Dean at least 5 working days before the hearing.

The relevant Associate Dean who refused access to less than full time training will also be required to provide a statement of case to the Postgraduate Dean at least 5 working days before the hearing.

Both parties will be given copies of each other’s statement of case.

The statement of case will allow the Postgraduate Dean to study all written material and should include the following:

The reason for appeal

A simple list of events in date order

Copies of all correspondence and written evidence

Details of any witnesses used

The Appeal Panel

The appeal will be heard by an independent appeals panel.

The appeals panel will comprise as follows: -

Postgraduate Dean (or nominated deputy) who will chair the appeal

One doctor in training nominated by the BMA

Lay person

The panel members will not have been involved in the original decision that gave rise to the appeal.

How the Appeal is Carried Out

The appeal will be a meeting between the panel, the relevant Associate Dean and the trainee.

The trainee, or representative, will be given the opportunity to put forward the reason for appeal.

The relevant Associate Dean will be given the opportunity to explain why the decision was made.

Any evidence additional to that included in the statement of case may be presented at this time provided both sides and the panel have been given a minimum of 5 working days to consider it fully.

Each side will have the opportunity to question the other on issues of fact.

Decision of Appeal

The decision of the panel, and the reasons for making that decision, will normally be announced at the end of the appeal; this decision will be confirmed in writing within 10 working days. If, for any reason, a decision cannot be made at that time, a further date may be arranged to hear any further evidence pertaining to the appeal

If the decision is not forthcoming on the day, it will be made known to both parties within a further 10 working days unless a further date is to be arranged.